Provider Demographics
NPI:1336317916
Name:GIBSON, ELIZABETH SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-0147
Mailing Address - Country:US
Mailing Address - Phone:304-439-4832
Mailing Address - Fax:
Practice Address - Street 1:100 HOYLMAN DRIVE
Practice Address - Street 2:GASSAWAY GLENVILLE PHYSICAL THERAPY SPECIALISTS, INC.
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624
Practice Address - Country:US
Practice Address - Phone:304-364-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist